In addition to phlegm-dampness, stasis blood (yūxuè) is also a common condition associated with the slippery pulse (huá mài). This condition can lead to vomiting and accumulation of blood, which is often observed in women during their menstrual period. Therefore, it is common for women to exhibit a noticeable slippery pulse, especially in the cubic pulse (chǐ mài), during their menstrual cycle or just before it. Furthermore, if a woman is pregnant, she may also present with a slippery pulse. Personally, I have limited experience in distinguishing between the slippery pulse during pregnancy and that during menstruation. Ultimately, it is necessary to rely on inquiry and ultrasound for accurate diagnosis. This may be a common issue among TCM practitioners trained in hospitals, but it is not a significant problem. Since there are more convenient and accurate methods to determine pregnancy, why insist on using pulse diagnosis?
In the past, without CT and MRI, it was impossible to determine whether a stroke was due to cerebral hemorrhage or cerebral infarction. Relying solely on physical examination and inquiry carried a certain risk of error. Nowadays, when a patient with hemiplegia arrives in the emergency department, the first step is to perform a CT scan, with other assessments taking a back seat. As for locating issues through neurological examinations, it is not as quick as imaging studies. Senior doctors often lament that the physical examination skills and logical reasoning of young doctors have declined, relying purely on imaging. However, without imaging examinations, it is indeed possible to miss or misjudge conditions, which reflects the advancement of technology; we should not dismiss it.
Pulse diagnosis is similar; however, its importance in TCM far exceeds that of physical examination in Western medicine. There is no need to reject modern technology in TCM; rather, we should use it to corroborate our findings and further enhance our pulse diagnosis skills.
Returning to the topic of slippery pulse, this year I visited a confinement center and examined hundreds of postpartum mothers. The slippery pulse was quite common among them, primarily due to lochia (è lù), as incomplete expulsion of lochia can easily lead to a slippery pulse in the lower jiao. However, there is also a tendency for postpartum women to experience insufficient qi and blood (qì xu, xuè xu), making the soft pulse (rú mài) also quite common, particularly at the cun and guan positions. One new mother had a retained placenta during delivery, and the doctor manually removed it, cautioning her to observe for any further discharge. After entering the confinement center, she underwent an ultrasound and found that there was still a significant amount of retained blood in the uterus. Subsequently, she passed a large blood clot and became concerned that the placenta might not have been completely expelled, contemplating a curettage. I happened to be on my rounds and checked her pulse, finding that the slippery pulse at the chǐ position was not prominent. I advised her that unless there was significant bleeding or other emergencies, it would be best to continue monitoring her condition. After two days, a follow-up ultrasound showed a significant reduction in retained blood. In my view, if the placenta had not been completely expelled, a slippery pulse would generally be present. The absence of a prominent slippery pulse at the chǐ position suggested that it had likely been fully expelled, and continued observation was appropriate. Of course, this should not be taken as absolute; if there were significant bleeding, immediate medical attention would be necessary. However, rushing into a curettage could cause excessive harm to the mother. Fortunately, my judgment was correct, and two days later, the follow-up ultrasound indicated a marked decrease in retained blood, with the obstetrician stating that there should be no issues. Throughout the confinement period, the mother’s lochia situation remained normal.